OP0289 SHORT- AND LONG-TERM EFFICACY OF ULTRASOUND-GUIDED NEEDLE FRAGMENTATION OR LAVAGE (BARBOTAGE) IN SYMPTOMATIC SHOULDER CALCIFIC TENDONITIS REFRACTORY TO SUBACROMIAL STEROID INJECTION. PROSPECTIVE LONGITUDINAL STUDY OF 181 PATIENTS.
Authors: E. Casado, S. Garcia-Cirera, S. Retamozo, M. Rusiñol, E. Costa Moya, L. Lluís, J. Calvet, J. Gratacos-Masmitja
Journal: Annals of the Rheumatic Diseases (2022)

Background Rotator cuff calcific tendinopathy is a common cause of shoulder pain and disability in young patients. Despite analgesics or steroid injection some patients still experience symptoms and may require surgery. Ultrasound-guided fragmentation or lavage are minimally invasive techniques that can be used instead of surgery to remove calcification and improve symptoms. However, evidence is poor because of most of published studies are retrospective or with few patients. Objectives To assess the short and long-term efficacy of ultrasound guided needle fragmentation or lavage (barbotage) in a large cohort of patients with symptomatic shoulder calcific tendonitis refractory to previous subacromial steroid injection. Methods Prospective study, including all consecutive patients referred to a Rheumatology out-patient clinic between Jul 2008-Dec 2020 because of symptomatic (visual analog scale or VAS≥4) calcific tendonitis of the rotator cuff refractory to at least one subacromial corticosteroid injection. After informed consent, all patients were treated with minimally invasive ultrasound-guided technique: fragmentation between Jul 2008-Dec 2013 or lavage (barbotage) between Jan 2014-Dec 2020. Corticoids were injected in the subacromial-subdeltoid bursa in all patients after procedure. Shoulder pain (VAS) and shoulder X-ray were assessed at baseline and after 4 months since the intervention. A new clinical assessment was made after 12 months or when clinical relapse occurred. Results One hundred and eighty-one subjects (56 men and 125 women), were included in the study. Mean age was 49.7 years (range 29 -72). Mean duration of symptoms was 33.0 months (2-150), with mean VAS 7.6±1.5. Right shoulder was the location most frequently affected (66,3%). Mean size of calcification by X-ray was 13.7 mm (5-40). 55 patients (30.4%) underwent fragmentation, 115 (63.5%) lavage and 11 (6.1%) both techniques. There were not significant differences between groups at baseline. 4 months after procedure, mean VAS pain was 4.5±3.8 and 82.9% of subjects experienced a X-ray resolution (56.8%) or size reduction (26.1%) of the calcification. A clinical relapse occurred in 73 patients (40.3%) in the first 4 months of follow up, and in 33 patients (18.2%) between months 4 and 12. Symptoms disappeared in most of patients with a new steroid injection. Only 31 patients (17.1%) required a second fragmentation or lavage, and 13 patients (7.2%) a rotator cuff surgery. Any patient suffered local or systemic complications after fragmentation or lavage. Patients treated with lavage had higher shoulder pain when clinical relapse (mean VAS 6.5 vs 4.0; p=0.01) and needed more frequently a new steroid injection (54.8% vs 34%; p=0.004) or ultrasound guided-procedure (17.5% vs 13.1%; p=0.008). There were no significant differences between both techniques in the radiographic resolution or size decrease of the calcification. Conclusion Ultrasound guided needle fragmentation and lavage (barbotage) are effective and safe at short and long-term to treat patients with symptomatic shoulder calcific tendonitis, avoiding surgery in more than 90% of cases. Fragmentation seems to have better clinical outcomes than lavage. References [1]Lafrance S, Doiron-Cadrin P, Saulnier M, et al. Is ultrasound-guided lavage an effective intervention for rotator cuff calcific tendinopathy? A systematic review with a meta-analysis of randomised controlled trials. BMJ Open Sport Exerc Med. 2019;5:e000506. Disclosure of Interests None declared